Individual
AMBER GIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4564 MOUNTAIN LAUREL DR, GRAND PRAIRIE, TX 75052-2902
(469) 797-4864
Mailing address
825 WATTERS CREEK BLVD STE 250, ALLEN, TX 75013-3770
(469) 797-4864
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
04/25/2022
Last updated
04/25/2022
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